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Results for “DECUBITUS ULCER”

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PubMed1991

[Factors predicting development of decubitus ulcers among patients admitted for neurological problems].

In this prospective study, factors contributing to the development of decubitus ulcers were examined. Factors were identified by a literature review and a conceptual framework was developed. Regular observations were made during the subjects' hospitalization to determine the incidence of decubitus ulcers, and to assess other decubitus ulcer risk factors. Seventeen out of 146 admitted for neurological problems patients developed decubitus ulcers during the three month study period. There were no significant differences in the level of serum albumin, hemoglobin or age between those who developed decubitus ulcers and those who did not. There also was no difference in incidence between patient who were paralyzed and those not paralyzed. Mean hospitalization days until decubitus ulcer development was 6.5 days. According to the results of discriminant analysis, four factors--1) friction and shear, 2) sensory perceptual impairment, 3) low diastolic pressure, and 4) multiple use of sedative medications--predicted 84.93% of decubitus ulcer incidence.

Humans↗
PubMed1982

Histopathology of the decubitus ulcer.

The histologic studies of the decubitus ulcer spectrum, which include blanchable erythema, nonblanchable erythema, decubitus dermatitis, decubitus ulcer, and the black eschar/gangrene reveal a dynamic process. The initial change occurs in the vessels of the papillary dermis. This is followed by necrosis of skin structures. The eschar/gangrene represents a full-thickness defect due either to prolonged ischemia and anoxemia or a sudden large vessel occlusion caused by shearing injury.

Adult↗
PubMed1997

[Nutritional status of patients with decubitus ulcers, and changes in the skin blood flow when the sacral region was compressed].

We studied the relationship between decubitus ulcers and changes in skin blood flow with respect to the presence or absence of a decompression medium. We also studied the relationship between decubitus ulcers and the results of biochemical tests that reflect nutritional status. Two groups of inpatients with decubitus ulcers in areas other than the sacral region were studied: One used cloth diapers and the other used paper diapers. Skin blood flow was measured with a laser Doppler blood flowmeter and a sheet of polyurethane (decompression medium) in the sacral region. Data were also obtained from patients with and without decubitus ulcers, and whose levels of albumin, total cholesterol, and triglyceride for three months were known. When the decompression medium was used, skin blood flow changed significantly after body position was changed in the patients who used paper diapers. Nutritional analyses showed significant differences in the levels of albumin and total cholesterol between patients with and without decubitus ulcers. The levels of albumin and total cholesterol were lower in the patients with decubitus ulcers than in those without decubitus ulcers. Because the cloth diapers acted as a compression factor, even an externally applied decompression medium did not suppress the reductions in skin blood flow.

Aged↗
PubMed1994

Prospective study of decubitus ulcers in two long term care facilities.

The incidence and prevalence of decubitus ulcers, and their complications and microbiology were studied prospectively in two large long term care facilities in Winnipeg, Manitoba between January 1, 1989 and December 30, 1990. The initial prevalence of decubitus ulcers was 2.6 and 1.6% at the two institutions, with an incidence of 3.4 and 4.8 per 100,000 resident days, respectively. The incidence of decubitus ulcer infection was 1.4 per 1000 ulcer days. The only other complication identified was in one resident who required an indwelling catheter to permit ulcer healing. An average of 2.4 organisms grew from surface swabs of ulcers; anaerobes were isolated from 14% of cultures. Aspirates from clinically noninfected ulcers had bacteria isolated in 30% of specimens. Two-thirds of organisms isolated were considered potentially pathogenic. Concurrent bacteriuria was present for 75% of sampling episodes. Organisms present in the urine were simultaneously isolated from decubiti in only 5% of specimens. Decubitus ulcers are uncommon in long term care institutions. The urinary tract of the bacteriuric elderly appears to be an infrequent source of organisms colonizing decubiti.

Adult↗
PubMedDate not supplied

Cautious use of administrative data for decubitus ulcer outcome reporting.

The purpose of this study is to demonstrate that caution should be exercised when using administrative data, exclusively, to report quality and safety outcomes. Investigators identified hospital-acquired decubitus ulcers using Agency for Health-care Research and Quality (AHRQ) patient safety indicator definitions. As validation of this method, investigators abstracted 123 medical charts of patients identified through AHRQ methodology as having hospital-acquired decubitus ulcers. Abstraction of these cases produced a change in rate from 23.3 decubitus ulcers per 1000 patients, derived through administrative data, to a true rate of 7.9 decubitus ulcers per 1000 patients, a 66% reduction. Investigators found 2 additional flaws (1 internal and 1 methodological) that further decreased the decubitus ulcer rate to 6.14 per 1000, a 74% variance. The results of this study suggest that administrative data, when used alone, are not sufficient in measuring the true rate of hospital-acquired decubitus ulcers.

Cross Infection↗
PubMed1991

Microbiological studies of decubitus ulcers in children.

Specimens from 58 children with decubitus ulcers were cultured for aerobic and anaerobic bacteria. Aerobic bacteria only were present in 29 (50%) ulcers, anaerobic bacteria only were recovered in 5 (9%), and mixed aerobic and anaerobic flora were present in 24 (41%). A total of 132 isolates (79 aerobes, 53 anaerobes) were recovered, an average of 2.3 isolates per specimen (1.4 aerobes, 0.9 anaerobes). The smallest number of isolates was recovered in ulcers of the skull (1.7 per site), and the highest number of isolates was found in ulcers of the buttocks (4.1 per site). The predominant isolates were Staphylococcus aureus (25 isolates), Peptostreptococcus species (22), Bacteroides fragilis group (10), and Pseudomonas aeruginosa (7). Forty-two of the organisms isolated from 38 (66%) patients produced the enzyme beta-lactamase. Most of the S aureus isolates were recovered from ulcers of the hand and the leg. Organisms that resided in the mucous membranes close to the ulcer predominated in the wounds next to these areas. Enteric gram-negative rods, group D streptococci, and B fragilis group predominated in ulcers of the buttocks. Group A streptococci, Haemophilus influenzae, Bacteroides melaninogenicus group, and Fusobacterium species were most frequently recovered in ulcers of the skull. The polymicrobial etiology of decubitus ulcers in hospitalized children and the association of bacterial flora with the anatomical site of the ulcer are demonstrated.

Adolescent↗
PubMed1996

The treatment of decubitus ulcers: a century of misinformation in the textbooks.

Decubitus ulcers are slow healing; in many cases they stagnate and fail to heal. Examination of the literature concerning decubitus ulcers reveals that there is a large body of treatments which have been suggested to stimulate the healing wound. This study examines the clinical effectiveness of the various treatments, and the scientific basis behind them. The treatments currently available are compared with those discussed in the literature over the last century, and common threads emerge which have a bearing on how literally one should accept the advice offered in current textbooks.

Anti-Infective Agents↗
PubMed2001

Topical phenytoin treatment of stage II decubitus ulcers in the elderly.

OBJECTIVE: To compare the healing of stage II decubitus ulcers with topically applied phenytoin sodium with two other standard topical treatment procedures in a long-term care setting; and to assess the extent of systemic absorption after topical application in the phenytoin group. METHODS: Forty-seven nursing home patients with stage II decubitus ulcers were chosen for this study. The patients were matched for age, gender, and size and severity of wounds, and randomly assigned to each treatment group. Clinical assessment of decubitus ulcers was performed at the beginning of treatment and at each dressing change. Ulcers were examined for the presence of healthy granulation tissue, reduction in surface dimensions, and time to healing. Two phenytoin sodium plasma concentrations were to be obtained on all patients in the phenytoin group. RESULTS: Topical phenytoin therapy resulted in a shorter time to complete healing and formation of granulation tissue when compared with DuoDerm dressings or triple antibiotic ointment applications (p < or = 0.05). The mean +/- SD time to healing in the phenytoin group was 35.3 +/- 14.3 days compared with 51.8 +/- 19.6 and 53.8 +/- 8.5 days for the DuoDerm and triple antibiotic ointment groups, respectively. Healthy granulation tissue in the phenytoin group appeared within two to seven days in all subjects. Patients in the standard treatment groups required six to 21 days to produce new granulation tissue. Serum phenytoin sodium concentrations were nondetectable. No patient withdrew from the study secondary to adverse treatment effects. CONCLUSIONS: Both the phenytoin and standard treatment groups showed progress over the study period. However, the phenytoin group demonstrated more rapid results in all aspects of ulcer healing.

Administration, Topical↗
PubMed2002

Prevalence of decubitus ulcer and associated risk factors in an institutionalized Spanish elderly population.

OBJECTIVE: We investigated the prevalence and associated risk factors of decubitus ulcer in an institutionalized Spanish elderly population. METHODS: A 1 d cross-sectional study in 50 Spanish geriatric facilities was carried out. Data collection included age, sex, body mass index, presence of decubitus ulcer, duration of ulcer, days of hospitalization, risk according to the Norton scale, associated risk factors, and nutrition status evaluation including assessment according to the Nutrition Screening Initiative. Logistic regression analysis calculated prevalence and association with risk factors. RESULTS: Data from 827 elderly people (71.3% female) were collected. Mean age (+/- standard deviation) was 82.4 (+/-8.0) y. Decubitus ulcer prevalence was 35.7%, with no sex differences (34.1% males and 37.2% females). Body mass index was inversely associated with ulcer prevalence in a statistically significant way (odds ratio = 0.94, 95% confidence interval = 0.92-0.97), but the following were risk factors: age (1.03, 1.01-1.06), previous ulcer (3.09, 2.16-4.04), diabetes (1.54, 1.02-2.51), functionality (2.91, 2.05-4.12), immobility (8.30, 5.09-11.51), erythema (12.12, 7.46-16.78), dehydration (2.09, 1.31-2.87), and edema (2.35, 1.64-3.06). Subjective evaluation of nutrition status and nutrition status as assessed by the Nutrition Screening Initiative Determine scale (modified) showed a significant linear association with ulcer (P < 0.001), and a score above 14 points in the modified Norton scale was associated with a lower ulcer rate (P < 0.001). CONCLUSIONS: Prevalence of decubitus ulcer in the Spanish elderly population increased with age, poor nutrition status, immobilization, and impaired functionality.

Age Factors↗
PubMed1980

Anaerobic and aerobic bacteriology of decubitus ulcers in children.

Forty-two children with decubitus ulcers were studied using aerobic and anaerobic techniques. Anaerobic bacteria were isolated in 21 (50%) of the patients, five times as the only isolates and 16 times mixed with aerobes. Aerobes only were present in 20 (48%) of the patients. There were a total of 83 isolates, 46 aerobes and 37 anaerobes, with an average of two species per specimen (1.1 aerobes and 0.9 anaerobes). The predominant anaerobic isolates were gram-positive cocci (17), Bacteroides fragilis (6), and Fusobacterium nucleatum (4). The most common aerobic isolates were Staphylococcus aureus (23), Group A beta hemolytic streptococci (6), Hemophilus influenzae (5), and Enterobacter agglomerans (5). The polymicrobial etiology of decubitus ulcers in hospitalized children is demonstrated.

Adolescent↗